Missouri voters set to vote on Medicaid expansion, bypassing GOP opposition

Missouri voters set to vote on Medicaid expansion, bypassing GOP opposition

Voters in Missouri will decide Tuesday whether to amend the state's constitution to extend Medicaid coverage to tens of thousands of low-income individuals and families.

The ballot measure, backed by progressive activists as well as state business and health groups, would expand the state's MO HealthNet program to anyone earning less than 133 percent of the poverty level, which is less than $18,000 a year for an individual and less than $30,000 for a family of three. 

According to Healthcare for Missouri, one of the groups spearheading the effort, it would mean coverage for more than 200,000 currently uninsured Missourians, and could result in up to $1 billion of savings. 

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It would also help rural hospitals, whose officials say Medicaid expansion is key to preventing their facilities from running out of money. Ten rural hospitals have closed in Missouri since 2014.

Front-line coronavirus workers would also benefit, according to expansion supporters. Due to Missouri's strict Medicaid requirements, they are likely to fall into a coverage gap — earning too much to qualify for Medicaid but too little to afford private insurance.

Missouri has one of the strictest Medicaid programs in the country. Adults who do not have disabilities and who do not have minor children living at home cannot qualify for Medicaid coverage, no matter how little money they make. Parents with dependent children can only earn up to 21 percent of the poverty level, which is about $2,700 each.

Missouri Republicans have blocked expansion efforts for nearly a decade, and the measure is not necessarily guaranteed to be successful. 

The state is solidly conservative, as President TrumpDonald John TrumpBubba Wallace to be driver of Michael Jordan, Denny Hamlin NASCAR team Graham: GOP will confirm Trump's Supreme Court nominee before the election Southwest Airlines, unions call for six-month extension of government aid MORE won almost 57 percent of the vote in 2016. Republicans, who have supermajorities in both the state House and Senate, are opposed to the measure, as is Gov. Mike Parson (R), who is up for reelection.

Parson has argued that expansion is not fiscally sustainable, especially as the state budget is straining under the impact of the COVID-19 pandemic.

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If passed, the proposed expansion would take effect on July 1, 2021. While some Republican governors have dragged their feet on implementing expansion even after it passed, or imposed conservative policies like work requirements, that won't be easy in Missouri.

Jonathan Schleifer, executive director of the Fairness Project, a nonprofit that has organized every Medicaid expansion ballot initiative to date, said amending the state constitution will effectively block Parson and GOP legislators from interfering with implementation if the measure passes. 

"So many elected officials, for no reason but politics, refuse to support Medicaid expansion," Schleifer said. "Like in Oklahoma, the campaign chose to put [expansion] in the constitution to prevent politicians from meddling."

Schleifer said he thinks Medicaid expansion has hit a tipping point, because there are so few holdout states left.

He noted that if the measure passes in Missouri, nearly 60 percent of House GOP members, and 60 percent of the Senate GOP, would be representing expansion states.

"As you increase the number of states [that expand Medicaid], you hit a tipping point where it makes it impossible for non-expansion states to oppose it. It's amoral and politically reckless" to resist expansion, Schleifer said. 

The path forward is not going to be easy, as only four of the remaining states that have not expanded Medicaid (excluding Missouri), have ballot referendum processes: Florida, Mississippi, South Dakota and Wyoming.

Florida is the campaign's biggest target, but Schleifer said the group is eager to work with all four states "to see if there's a path to expansion."   

Under ObamaCare, states have the option to expand Medicaid to cover more low-income adults, with the federal government picking up most of the costs. Missouri remains among the 13 states that have not adopted Medicaid expansion.

In recent years, expansion supporters have circumvented that opposition by making their case directly to voters. 

Missouri is the sixth state in three years to vote on a Medicaid expansion ballot measure.  Oklahoma approved expansion at the beginning of July, following successful initiatives in Utah, Nebraska and Idaho last year. Those followed a 2017 success in Maine.